Militant moderate, unwilling to concede any longer the terms of debate to the strident ideologues on the fringe. If you are a Democrat or a Republican, you're an ideologue. If you're a "moderate" who votes a nearly straight party-ticket, you're still an ideologue, but you at least have the decency to be ashamed of your ideology. ...and you're lying in the meantime.

Tuesday, January 25, 2011

Healthcare Reform for Dummies

My battles with the company’s health insurance carrier are legendary. From bawling out the computer-generated voice that pleasantly informs me, “I didn’t quite catch that ... did you say ‘Fuck you, you brainless automaton’? I don’t know how to do that...” to demanding to speak to a supervisor before the first level real-person nincompoop can have a crack at me, to sending emails that spontaneously combust when opened. No one I’ve sat in an office with – ever – would come close to supporting the notion that me and insurance companies are tight, unless they were describing my fingers on their throats.

I can tolerate life, auto and homeowners insurance companies ... if I’ve had a glass of wine and an anti-depressant. But health insurance companies make my blood boil. I’d like to think I return the compliment to those health insurance retards I’ve personally dealt with.

My company currently uses Aetna. The only carrier worse than Aetna is United Healthcare. The only one worse than that was ... hell, they’re all the worst. I’ve had several.

In 1996 my oldest son drove the riding mower into a ditch and I – body-double for Lou Ferrigno that I am – hoisted it out with a clean and jerk. I was successful, but my form deducted badly from the judges’ scores and I ended up going to the doctor the next week with what I thought was a pulled hamstring. Turns out it was a herniated disk; very shortly it went acute, as they say. Flaming, stabbing, tearing pain from the middle of my right ass cheek down to my pinky toe. I passed out walking across the front yard. My leg was as useful as a wooden peg and, pain notwithstanding, had as much feeling.

The doctor knew my nucleus pulposus was impinging both my spinal column and my sciatic nerve [L5-S, for anatomists], and that without surgery, and soon, I would have permanent nerve damage. But – because I had health insurance – I was required to undergo the treatment that the actuaries and CPAs at the insurance company set out for me.

The doctor sent me to physical therapy doped up on pain killers and muscle relaxers, because a majority of “back problems” will go away or be remediated with exercise and medication – because the majority of “back problems” aren’t acute, they are chronic. I was required to undergo several weeks of unsuccessful physical therapy before the accountants would allow any diagnostic tests to be performed. You know, like an MRI. And then only in the order they allowed, and only if the prior test showed “enough” damage to warrant the next test on the list.

My back went acute the morning after my first session of physical therapy after I had gone downstairs to get a cup of coffee, so one could even argue that “conservative treatment” made me worse. Seven weeks later, after having had some kind of thoroughly forgettable first test, I was scheduled for an EMG. The doctor performing it studied under Josef Mengele. ...which was odd, being as this doctor was Jewish. He laughed when I noted the irony in that, and turned up the voltage on the needles. My electromyography indicated what the CPAs at the insurance company had made certain would happen: I had nerve damage in my right leg due to their rules. How much, I asked. “Moderate”, he replied.

Happy day! I have moderate nerve damage!! I could now – after 9 weeks – have the MRI I should have had the day my annulus fibrosus tore and spilled its contents into my neural channels. The MRI clearly [clearly to the neurosurgeon, I dutifully nodded and said, “Sure, I see that...”] showed a severe prolapse that would have indicated surgery almost immediately if I’d had my MRI sooner, thus preventing quite a bit of nerve damage. As it was – thanks to insurance requirements – I had a microdiscectomy nearly 11 weeks after the initial injury. That afternoon I was up and walking, walking, walking, pain-free – in comparison to how I’d been for nearly three months – bare butt hanging out the back of the gown.

Afterward, I went back to the physical therapist whose job it was to get me back into shape so they could conduct their neural deficit test. The insurance company was pleased to learn that due to their playing doctor and rendering my doctor into a bureaucrat, my right leg enjoys 25% nerve damage. They must have been pleased: they paid the bill. Another successful outcome!

To this day I have numbness and tingling, periodic bouts of stabbing pains in my ass, hamstring, and calf, and sporadic demons with 8-lb sledges pounding on my heel or my peronaeus brevis. Cramping is a major issue, and particularly when I sit still for prolonged periods [like driving], and my right foot is just about always permanently cold. And this doesn’t include the muscular atrophy. Thank you, health insurance company. I can’t tell you how much it means to me that you were there to help me through this. What a quality-of-life saver you turned out to be.

Thanks again.

That was nearly fifteen years ago. Since that time, of course, certain people have come to the conclusion that we need “healthcare reform” in this country. Actually, some of those certain people had concluded that earlier, and gave us Medicare and Medicaid as a result. Wuptidoo.

And why do we need this health care reform? Because insurance companies run the industry and they run it badly – people are dying. “We need a system like ... [fill in your favorite social-democracy]!”

Well, okay, then. Insurance companies having too much authority to be doctors...? Doctors being relegated to technocrats in order to get paid...? Yes, that’s a problem. No argument here. In fact, if you’d like a few sesquipedalian adjectives, and some colorful and uncomplimentary turns of phrase for your argument that health insurance companies are too controlling and manipulative of the system, let me know. I’ll donate my efforts.

But there is no health care system in the world better than ours. A health care system is measured by how long people live. US life expectancy is up there at the top of the world’s chart, and while critics point at certain countries which are above the US, only a few show a cumulative life expectancy that exceeds the US by greater than the margin of error.

Which means that for all practical purposes – and despite the specific areas of concern we legitimately have – the rapacious, insurance-megalith system is no better or worse than the socialist system everyone points at as better. And considering that the US lifestyle with its fat-heavy, salt-saturated junk food, high-calorie sugary drinks and sedentary couch potatoing is statistically even with all the “superior” socialist “Everybody gets care” systems in nations which have a better diet and a more active lifestyle ... suggests instead that there’s something wrong with socialized medicine. By all accounts, US life expectancy should be down there next to Mother Russia and her potato vodka liver-pickled population.

But still: “Insurance is the problem!” THE problem? No. A problem, yes.

Nevertheless, armed with an Easy Answer®, we embarked last year on a massive legislative proposal for “healthcare” “reform” [I will digress on this phrase later – remind me]. Insurance is the problem, and to fix it we require everyone to have health insurance.

Let’s ignore for the moment that only a third of our Of, By and For the People country wanted “healthcare” “reform” in the first place [for the one-sixth who are uninsured, and one-twentieth who are involuntarily uninsured], even among those of us who loathe health insurance companies; Congress gave it to us anyway. Instead, let’s look at the thought [sic] processes of the healthcare reformers.

Insurance is the problem, so the solution is ... more insurance?

Let’s suppose you go to the doctor with a headache, and he takes an X-ray and discovers, “Hmm, your problem is that you have a bullet lodged in your brain.” What kind of delusional idiot would suggest that the solution to this problem would be to put another bullet in your brain? The answer to that is: Liberals, democrats, and [ironic term] “progressives”.

They rationalize this lunacy by saying that, really, the “healthcare” “reform” proposal needed to have a “single-payer” or government option included, so that the government, and not the insurance companies, would cover medical procedures. “Obamacare isn’t enough!”

...which means that the government would be acting as an insurance company – or THE insurance company if certain people get their wish.

We’re right back to the same question the microcephalics just dodged: If the problem is a bullet in your brain, what kind of delusional idiot would suggest that the solution this time would be to put a government bullet in your brain? If, as we are told, “the problem is insurance”, then the solution cannot be more insurance, government-run, government-mandated, or both, unless you want to magnify and multiply the current problems.

And haven’t we already seen enough evidence that the government cannot run health insurance programs any better than health insurers do? We already have two government-run health insurance programs ... mentioned above: Medicare and Medicaid. Anybody who’s on ‘em like ‘em? Not many. For most, it’s just “better than nothing” and chosen only because it’s all there is. Medicare requires supplemental insurance before it actually pays for much, and – according to charges made in a lawsuit filed yesterday in Vermont – Medicare doesn’t even pay for those things it’s required to pay for. It is, as predicted of our new Obamacare system, rationing medical care – what Liberals, democrats and [ironic term] “progressives” claim only happens with free-market health insurance, but would not happen with government health insurance. It already is happening.

Medicaid has, for decades, been swamped with charges of, and convictions for, fraud; failure to reimburse “healthcare providers” [can we use “doctors” and “hospitals”, please?]; dropping coverage outright [the same criticism leveled at traditional health insurers]; and denying coverage [ditto]. In other words: rationing healthcare and for more cost than necessary – just like health insurers.

A government-run health insurance program would be better than what we’ve got?

Not according to any evidence.

One can even make the argument that because traditional health insurers are in business to make money and that government is profit-neutral [in theory; in practice they are profit-hostile], that government-run coverage is worse. At least someone is profiting from idiot health insurers, even if it’s only the shareholders. In this day and age of mutual fund-heavy 401(k)s and IRAs, that’d be most of us.

So again: if the problem is that insurance isn’t run by the government, why are we failing to look at current government-run insurance programs as the twin bullets already lodged in our noggin as reason enough to not do more of the same? What is so great about shooting oneself in the head with stupid, pointless, disproven ideas that Liberals, democrats and [ironic term] “progressives” continue to do it again and again and again?

Why does their “reform” invariably mean “more of what doesn’t work”?

And speaking of ... I promised a digression on the idiot’s phrase “healthcare” “reform” being used to describe the Chimera-trap of Obamacare. Here it is.

Healthcare is going to the doctor, having him whack your knee, stick a nozzled light in your ear, gag you with a stick and give you a prescription for aspirin. Healthcare is going to the hospital, having them X-ray your arm and wrap it in gauze and plaster, and sending you on your way with a lollipop.

The government doesn’t do that for its citizens, and won’t do it under Obamacare. There is no healthcare in this “healthcare” “reform”. The only thing the government is claiming to do is pay for any healthcare you may get – which, as we’ve seen, may never happen.

That makes it health coverage – and no better than what we have.

The government does provide healthcare to a very small, select group of Americans – and nearly universally those Americans despise it, and we despise it for them when they no longer can; it’s called VA hospitals, staffed by those who couldn’t land a job folding bedpans at a real hospital or hack it in private practice. Show of hands: who wants government health care?

Furthermore, “reform” means to do something differently [ideally better, but that’s iffy]. All Obamacare is purporting to do is what was already being done and that many people believe didn’t work [“at all” versus “well” is debatable] in the first place … only doing more of it, mandatorily, and with a layer of government bureaucracy added in – because the insurers’ own bureaucracy apparently isn’t enough.

The American healthcare industry is corrupt and failing because, we’re told, health insurance effectively breaks us into a two-tiered nation: those who can get the medical treatment they want or need, and those who ... have to use the emergency room to get the medical treatment they want or need and then don’t pay for.

...as opposed to Canada, Britain, France [et cetera] who have systems where all citizens are given the same care by the same doctors paid by the government.

Except every single nation with these “superior” systems is also two-tiered. Those who have to endure the government-rationed healthcare because it’s all there is for them, versus those who pay to go to a private hospital for actual medical attention, or fly to the US for same. How long does it take to renew your plates at the DMV, where the transaction consists of giving the government employee a pre-printed form and a check, and getting back a sticker? Pay workers by the transaction, a few seconds; pay workers state scale, you can be in a line of six for an hour – and I have been. And so have you; don’t lie. And they kick us out of the building at 5 o’clock whether we’re already in line or not.

Now imagine the DMV behind the glass at your doctor’s office and the doctor is the guy you take your driving test with. They get paid the same regardless of how many patients they see or what the outcome is. There’s a reason the VA medical system attracts the dullest and dimmest “caregivers” we have.

And there’s a reason that Canada has [quietly, in the US press] called for ideas on how to improve the time it takes between when you call the doctor for an appointment and the time you can see him – it’s weeks. And how to reduce the cost to the nation, because Canada’s going broke.

And there’s a reason that Britain is now asking for ideas on how to increase their medical emergency survival rates from “pitiful” to those seen even in Mother Russia. And how to reduce the cost, because they’re going broke, too.

And there’s a reason that France cut to the chase and offered – for those willing to pay extra, in installments even, proportioned to how much you use it – a legitimate entry into that second tier of their medical system where you get better care. What they offered was [hold onto your hats and send the children to the other room] insurance. They did this because they’re going broke.

And it’s not confined to rich countries with large populations. We went to Nassau, Bahamas in ’07 and rode around town in a horse buggy driven by a kid of 25 or so. He pointed out the hospital Anna Nicole Smith gave birth in, her son died in, and she would later die in. If you have $500 [payable at the door] you can get in and a doctor will see you right away – “Like the US” we were told. A few blocks later he pointed out the hospital for those who do not have $500, where you go for free, to wait in line and die because you’re too ill, or leave after getting better on your own ... because the doctors are all on break.

In other words: the rest of the world with Mommy Government Healthcare is discovering that our system is better than theirs just as we get fed up with ours in order to try theirs. Trading known problems for other known problems is musical chairs for dummies – two chairs, one dummy. It’s no wonder Liberals, democrats and [ironic term] “progressives” like the idea so much.

Except we aren’t even trading known problems. We aren’t getting rid of those parts of our system where we acknowledge the problems to be; we are instead doubling down on it. Second helpings. Putting the Stupid Idea gun against our temple and pulling the trigger because the first stupid idea rattling around in our nation’s windswept skull was lonely.

Insurance is the problem? More insurance!!

Bureaucratic rendition of medicine is the problem? More bureaucrats!!

I’d continue this essay, but two things occur to me: I would only be flexing my imaginative insult muscles in repeating the same argument, and second, I’ve been sitting for an hour and a half and my foot is numb and tingling. Old injury.